Assisted dying legislation appears to be working well in Alberta

There was a panel discussion after presentations at the Palliser Friends of Medicare meeting Feb. 15. From left Dr. David Amies, with Dying with Dignity Canada; Nancy Campbell, Alberta Health Services South Zone co-ordinator for MAID; Colin Zieber, executive director, seniors health and operational lead for MAID, AHS South Zone; and Dr. Dionne Walsh, palliative physician and medical lead for MAID, AHS South Zone.Southern Alberta Newspapers photo by Gillian Slade

An interested group of about 50 people had the chance to learn more about the Medical Assistance In Dying (MAID) process and how it works in the South Zone of Alberta Health Services.

Palliser Friends of Medicare held the information session as part of its annual general meeting Feb. 15. In attendance presenting information were Dr. Dionne Walsh, a palliative physician and medical lead for MAID in the South Zone, as well as Dr. David Amies, with Dying with Dignity Canada, a patients’ rights organization. A panel discussion, with the addition of Nancy Campbell, South Zone co-ordinator for MAID as well as Colin Zieber, executive director, seniors health and operational lead, MAID, AHS South Zone, capped off the evening’s events.To date since last summer there have been 10 assisted deaths in the South Zone of Alberta Health Services, shared Dr. Walsh, who talked about the process for people to request an assisted death.“We have been able to accommodate both the day and the location (those people requested),” she added.Statistics about MAID are provided on a website on a weekly basis. As of Feb. 20, there have been 87 people provided with medical assistance in dying in Alberta, and 48 people who have been denied as they did not meet the federal criteria.The most cited health conditions of people wanting MAID services are cancer, multiple sclerosis and amyotrophic lateral sclerosis. Reasons for ineligibility have included mental health diagnoses, loss of capacity or competency and that death is not reasonably foreseeable. The average age of people receiving the service is 65 in the south zone, but ranges from that as a low to 88 as a high across the province.Dr. Walsh said there is a difference between MAID and palliative care. “Palliative care is about living with quality while you are alive,” she explained. “We provide medications and emotional support to lessen the symptoms a person may have. It’s about quality of life rather than prolonging life.”Palliative care doesn’t hasten or postpone death, it merely alleviates a person’s symptoms. The biggest intervention made in palliative care is known as palliative sedation. When a person’s symptoms can’t be brought under control, a continuous infusion of medication can be given to keep the person sedated. On June 17, 2016, the federal government passed assisted dying legislation which came with some rules that have to be followed. Those include that the person seeking help in dying has to be an adult; competent to understand the decisions being made right up until the medication is administered; have a serious illness that cannot be cured, is suffering and at an advanced state of irreversible decline in capabilities; and that natural death needs to be reasonably foreseeable.The use of the phrase “reasonably foreseeable” has caused some concern.“That is not a legal or medical term that people know what that means,” said Dr. Walsh.If a person wants medical assistance in dying, he or she needs to make a written request, or if incapable of writing, have it done by proxy and it needs to be signed by two independent witnesses, who would have no financial benefit from the patient’s death. Then there are two independent assessments completed which can be done by doctors, nurse practitioners or a combination of both.The patient has the right to withdraw the request at any time. There is a legislated 10-day reflection period in between the request being made and when the assistance in dying is carried out. That 10-day period can be waived for a few reasons. The federal government is committed to reviewing the legislation and certain portions of it by the end of 2018. Some of that review could include looking at requests by mature minors (age 17), as well as how advanced directives could come into play.Through MAID, the co-ordination of care is done so there are no barriers for patients. AHS officials working in this area help ensure access to services such as finding a willing doctor, arranging transportation and the needed medications from pharmacists, and working with the patient and his or her family. Inquiries about assistance in dying can be made through a physician, a nurse or simply by phoning Alberta’s Healthlink at 811. A nurse co-ordinator would meet with the patient to discuss the request and answer questions. “If the patient is in the action phase, then they would discuss the rest of the process,” adds Dr. Walsh.These care co-ordinator nurses help arrange the particulars with the patients including where and what day the patient may want to die.“It’s a difficult question and often hits home,” says Dr. Walsh. “We ask who do you want to be with you at that time. We’ve had people with more than 20 with them and it’s a celebration, and others who want to be alone.”There are two kinds of assisted death. The first is assisted suicide, where the patient is given oral medication he or she administers to him or herself. The second is voluntary euthanasia, where a physician or nurse practitioner administers the medication to the patient.After the patient dies, there is follow-up with the family to ensure they are receiving the supports they need.Dr. David Amies also spoke. He sits on the Dying with Dignity Lethbridge Chapter and provided a brief history of the introduction of medical assistance in dying legislation.The biggest problem with the legislation brought forward is the “extraordinarily vague term” of reasonably foreseeable. Other defects included that it excluded minors and advanced directives.“For example, someone suffering early dementia, couldn’t decide they wanted assisted death when they reached a certain stage of dementia,” added Dr. Amies.Dying with Dignity Canada works to help organize training for physicians and nurse practitioners who are interested in taking part in the assisted dying procedure, as well as trains people who would like to act as witnesses for others. He said Canada has already gone through a big change in just allowing for assistance in dying and the country continues to grapple with issues of religion and beliefs. There is also some concern from physicians’ perspectives about the amount of time these cases can eat up and the impact on their practices. Dr. Amies believes there will be a slow and steady uptake of MAID services in the coming months and years. He is hopeful the reviews of the legislation being done by the end of 2018 will be made public, even though there is no requirement to do so.More information about the organization is available at dyingwithdignity.ca, and Dr. Amies said he can assist in helping set up a Medicine Hat chapter of the organization — if there is interest.During the panel discussion Dr. Amies commended Alberta Health Services and the system that has been set up for MAID services.“We have been meeting the demand in the province,” said Campbell. “I think AHS has done well for meeting the demands for something that is very new ... The teams have worked very hard to meet people where they’re at with their requests.”“Alberta has taken the approach that meets people where they are at in their local area,” added Zieber.A question was asked about the approach by faith facilities and some others, who have chosen not to administer MAID, such as Covenant Health, the Catholic health system in Alberta. “We’re working with them as a partner,” said Campbell. “The conversation has been ongoing ... They support us in going in and having those conversations and assessments done (with patients). We do have to remove (those people) to alternative sites for the event itself.”Zieber said many providers are still determining how to deal with MAID in their facilities.“It is only nine months old, this law. It is going to evolve,” said Dr. Amies. “I think it will become more acceptable and more accessible.”“Categorically there is no black and white,” added Campbell. “Each patient’s and family’s journey is unique ... This is weighted work. There is not a physician or a practitioner that doesn’t recognize the weight of this work. This is a paradigm shift in health care, and people are taking this very seriously.”Information about MAID in Alberta, including statistics about number of cases, is available on Alberta Health Services website at: http://www.albertahealthservices.ca.